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GENITAL LISTERIOSIS IN THE MALE
482
tric artery is ligated, a gastrectomy clamp is applied to the stomach from incisura to fundus or to the adjoining greater curvature. A Hofmeister valve is constructed in the usual way; the stoma lies at the fundus and is at a higher level than the incisura. The extent of resection of acid-secreting area obeys the time-honoured principle of removing from a half to twothirds of the stomach in gastrectomy for duodenal ulcer. The stomach will now consist of a tube formed from the lesser curvature and part of the body of the stomach. The path of the food through this pouch will resemble as nearly as possible that in the normal stomach. In this way the food will be retained for a longer period in the stomach. Results
The operation was performed on ten patients and in all the postoperative period was smooth and uneventful. Fractional test meal performed one month after operation demonstrated a satisfactory reduction in acidity. Study of the gastric pouch by barium meal (fig. 2) one month after operation showed:
(1) The stoma lying in the region of the fundus and at a higher level than the incisura. Swallowed barium passed along the lesser curvature, collected in the region of the Hofmeister valve, which functioned in a way similar to the pyloric antrum, and then passed through the stoma into the jejunum. (2) The average emptying time of the gastric pouch was 2/z hours. The
and
so
of far all the
period
follow-up varies from 6 to patients are symptom-free.
20
months,
Summary A
line of resection of the stomach to prevent rapid emptying of the gastric pouch after gastrectomy for duodenal ulcer is suggested. The anatomical and physiological basis of this procedure is explained. The operation has been performed on ten patients. new
REFERENCES
Capper, W. M. (1951) Proc. R. Soc. Med. 44, 777. Edwards, H. (1954) Recent Advances in Surgery. London. Glazebrook, J. C., Welbourn, R. B. (1952) Brit. J. Surg. 40, 111. Machella, T. E. (1949) Ann. Surg. 130, 145. Wells, C. (1955) Ann. R. Coll. Surg. Engl. 16, 145.
GENITAL LISTERIOSIS IN THE MALE R. TOAFF
N. KROCHIK
M.D. Pisa
M.D. Cordoba
HEAD
ASSISTANT
DEPARTMENT OF OBSTETRICS A
M. RABINOVITZ B.A Beirut BACTERIOLOGIST
THE MUNICIPAL HOSPITALS,
TEL-AVIV, ISRAEL
WE have previously described a form of human listeriosis-genital listeriosis-as a latent infection of the genital organs of apparently healthy women by Listeria monocytogenes (Rabinovitz et al. 1959, Rappaport et al. 1960). This manifests itself by long-continued excretion of microorganisms from the uterine cervix, and by abortion or premature stillbirth in supervening pregnancies. At that time we thought genital listeriosis was a specific
disease of the female. A further step has been made by extending the bacteriological investigations to the male partners of habitual aborters. We now submit evidence that listerial infection may affect the genital organs of apparently healthy men, and cause impairment of reproductive capacity. While L. monocytogenes has never been isolated from
(Gray 1960), it has been isolated from the semen artificially infected sheep and goats (Khalimbekov 1957), and also from the testicles of a rabbit that died 6 days after nasal exposure and a ram killed 7 days after oral exposure (Osebold and Inouye 1954).
human
semen
of naturally and
Subjects and Methods Between November, 1959, and December, 1960,
we
examined the husbands of sixty women who had had repeated abortions. 1-8 semen examinations, but usually 3, were done in each case. The specimens were collected by masturbation after at least 5 days’ abstinence, to prevent fresh contamination of the penis and urethra by the female genital secretions. The men, none of whom had a urethral discharge, were asked to wash the penis and hands thoroughly with water and soap and to rinse them repeatedly with sterile water before masturbation. The ejaculate was collected in a sterile jar. Each specimen, after removal of a swab for bacteriological investigation, was examined routinely for volume, count, motility, and morphology. The swabs were cultured immediately, and then kept in a refrigerator for a month so that weekly cultures could be taken. The culture medium, the method of culture, and the criteria for identifying colonies in positive cases were the same as previously described (Rappaport et al. 1960).
In three
identified
as
cases the isolated microorganisms L. monocytogenes, serotype 4b.
were
THE FIRST CASE
A merchant of 47, born in Iraq but who had lived in Israel for 8 years, had been married for 12 years. His wife, aged 38, had had six spontaneous abortions (in the 2nd-4th months) in the first 10 years, and had since been sterile, despite a conservative operation for fibroids of the uterus. The first sperm examination, done in 1957, had shown: Quantity of ejaculate 1-5 ml. No. of spermatozoa 26 million per ml. 1-hour motility 40%, 3-hour motility 20%. Immature and abnormal forms numerous. Leucocytes and erythrocytes present.
During investigation of the wife L. monocytogenes, later identified as serotype 4b, was cultured successively from the cervical secretions on Dec. 3, 7, and 14, 1959. The sperm was therefore examined and cultured on Jan. 4, 1960: Quantity 1-5 ml. Sperm no. 58 million per ml. 1-hour motility 40%, sluggish; 4-hour 20%; 10-hour 10%. Abnormal and immature forms 26%. Culture: L. monocytogenes, later identified
as
serotype 4b.
Antibiotic treatment was started on Jan. 20. Procaine penicillin 17 million units was given in 14 days, followed by oral demethylchlortetracycline 12-6 g. in 14 days. On Feb. 22 the sperm examination was repeated: Quantity 2 ml. Sperm no. 52 million per ml. 1-hour motility 70%, very active; 4-hour 40%; 7-hour 40%; 24-hour 5%, sluggish. After this striking improvement, the wife was given treatment with crystalline penicillin 28 million units in 14 days. In May she conceived; and, after an uneventful pregnancy but with repeated courses of antibiotics, she was delivered by elective caesarean section of a healthy boy (birthweight 7 lb. 11 oz.) on Jan. 23, 1961. After conception, the husband refused further sperm examinations. THE SECOND CASE
A blacksmith of 37, born in Iraq but for 8 years in Israel, had been married for 6 years. His wife, aged 27, who was also born in Iraq, had once aborted in the 3rd month, and had had three premature stillbirths of macerated fcetuses at 8 months. During her fourth pregnancy, she was admitted to hospital with definite signs of placental insufficiency. Gram-positive rods were repeated by isolation from the cervical secretions, and these were later identified as L. monocytogenes, serotype 4b. Despite immediate antibiotic treatment, the foetus died in utero. The husband’s sperm was examined shortly afterwards (on
483 Dec. 30,
1959), when the couple had
not
yet resumed inter-
course :
Quantity 1-5 ml. Sperm no. 23 million per ml. 1-hour motility 25%, 4-hour 15%. Eosin tests 65% and 45%. Abnormal and immature forms 35 Cultures: repeatedly positive for L. monocytogenes, serotype 4b. A bilateral testicular biopsy was performed on Feb. 18, 1960. No gross pathologic changes were observed (Dr. C. Joel), no bacilli were found in gram-stained histological sections, and cultures from the biopsy specimen remained sterile. The wife, who had been treated repeatedly with antibiotics (penicillin, demethylchlortetracycline, and chloramphenicol), conceived again with unexpected ease after 3 months. Her fifth pregnancy was uneventful and she was delivered of a normal boy by elective caesarean section on Sept. 6, 1961. The husband has not had antibiotics, and in October, 1961, sperm examination showed: Quantity 1-5 ml. Sperm no. 33 million per ml. &mid ot;
1-hour motility 65%, 4-hour 40%. Abnormal and immature forms 35 Repeated cultures: negative for L. monocytogenes. Only Proteus vulgaris was grown, the presence of which may possibly prevent the growth of listeria. THE THIRD CASE
An engineer of 34, born in Austria, who had lived in Israel for 24 years, had married at the age of 30. His wife, aged 32, had had two pregnancies, which had both ended in early abortions in February and November, 1958. During investigation to establish the cause of the infertility, a sperm examination was made on Jan. 20, 1959: Quantity 4 ml. Sperm no. 51 million per ml. 1-hour motility 50 %, 2-hour 30 %. Abnormal and immature forms 62%. Mucolysis incomplete after 3 hours. On Jan. 29 the examination was repeated: Quantity 3 ml. Sperm no. 102 million per ml. 1-hour motility 30 %, 4-hour 10 % Abnormal and immature forms 67%. A testicular biopsy specimen, taken on Feb. 5, revealed "impaired spermatogenesis, catarrh of the seminiferous tubules with considerable shedding of cells, and a reduced number of spermatozoa " (Prof. A. Laufer). Hormonal tests of the urine showed: 17-ketosteroids, 28 mg. per 24 hours; oestrogenic substances, less than 25 i.u. per litre; folliclestimulating hormone 50 r.u. per litre. Rebound treatment with large doses of testosterone was given during June and July. 4 months later the sperm-count was back to normal, but there was no change in the motility or cell form. 3 specimens were therefore cultured on Dec. 31, 1959, and Jan. 3 and 16, 1960. The first and third were positive for L. monocytogenes, and the first was later identified as serotype 4b. Treatment was started in February, 1960, with demethylchlortetracycline 8’4 g. in 14 days, followed by procaine penicillin 11,200,000 units in 14 days. But 4 months later sperm examination was still very unsatisfactory: Quantity 3-5 ml. Sperm no. 34 million per ml. 1-hour motility 45%. Abnormal and immature forms 38%. After a further course of demethylchlortetracycline 12-6 g. in 14 days, sperm examination (on Nov. 16) showed: Quantity 4 ml. Sperm no. 78 million per ml. 1-hour motility 75%, 4-hour 55%, 24-hour 15 Abnormal and immature forms 28%. Culture: negative. About this time 8 cultures from the wife’s cervical secretions were constantly negative. Shortly afterwards she conceived ; the pregnancy was uneventful, and a healthy boy was delivered on Jan. 25, 1962. &mid ot;
&mid ot;
Discussion
We have found dyspermia (in the form of reduced spermcount, mobility, and viability of the spermatozoa, teratospermia, and incomplete mucolysis of the seminal fluid) associated with L. monocytogenes in the ejaculate of three men whose wives had sought advice over repeated miscarriages. Two of the women had genital listeriosis, while in the third listerial infection could not be proved. It is therefore important to know whether the presence of
listeria in the ejaculate is a manifestation of active infection of the male genital organs, with xtiological significance in the production of dyspermia, or whether it is merely the result of contamination of the male urethra by the genital secretions of chronically infected women. To reduce the chances of fresh contamination of the urethra, abstinence was the rule-for 5 days before the semen was collected for bacteriological study. Case 2 had abstained for much longer, however, and in case 3 the wife was apparently unaffected by genital listeriosis. Thus passive contamination does not seem to explain the presence of L. monocytogenes in the ejaculate of at least two of the three cases under discussion. But a stronger argument favouring this negative conclusion in all three subjects concerns the nature of the dyspermia; its characters, and the excellent results of antibiotic treatment, point more to a chronic infection of the adnexa than to
faulty spermatogenesis. The finding of L. monocytogenes in the semen and testicles of animals shortly after exposure to infection by other than the genital route (Khalimbekov 1957, Osebold and Inouye 1954) supports the possibility that there may be genital localisation of listeria in man. None of our patients had urethral symptoms. Testicular localisation is not borne out by the normal biopsy findings in case 2, but it cannot be excluded in case 3, where there was the possibility of a mild orchitis. The absence of gram-positive rods in stained slides does not prove the contrary. Treatment with penicillin and demethylchlortetracycline restored the impaired reproductive capacity in two of the three affected men. In all three women, normal pregnancy followed the detection and treatment of listerial infection and resulted in a healthy child after multiple pregnancies which had ended in miscarriages. In the two cases where both husband and wife were affected, the listeria strains belonged to serotype 4b. This would be compatible with venereal transmission of the infection, but it does not prove it because all nine cases of genital listeriosis which we have serologically typed belonged to this same strain, which seems to be prevalent in this country.
Summary The semen of sixty husbands of habitual aborters were submitted to bacteriological investigation. In three cases Listeria monocytogenes, serotype 4b, was isolated, and the quality of the sperm was poor. The characters of the dyspermia pointed to chronic infection of the adnexa in two cases, and to testicular localisation of the infection in the third. Two of the wives had genital listeriosis, caused by the same strain of listeria (serotype 4b). After detection of the listerial infection and antibiotic treatment, the impaired fertility was restored and normal babies were born. We are indebted to Prof. H. P. R. Seeliger, of the Institute of Hygiene, University of Bonn, and Dr. M. L. Gray, of the Veterinary Research Laboratory, Montana State College, Bozeman, for the identification and typing of cultures; to Dr. C. A. Joel, of the Institute for the Research and Treatment of Infertility, Municipal Hospital, Tel-Aviv, for the testicular biopsy in case 2, and to Prof. A. Laufer, of the Institute of Pathology, Hadassah University Hospital, Jerusalem, for the testicular biopsy in case 3. This work was supported in part by a research grant from the Lederle Division of Cyanamid International, Pearl River, N.Y.; and they also supplied the demethychlortetracycline (’Ledermycin’). REFERENCES
Gray, M. L. (1960) Lancet, ii, 315. Khalimbekov, M. M. (1957) Vet., Moscow, 34, 17. Osebold, J. W., Inouye, T. J. (1954) J. infect. Dis. 95, 52, 67. Rabinovitz, M., Toaff, R., Krochik, N. (1959) Harefuah, 57, 277. Rappaport, F., Rabinovitz, M., Toaff, R., Krochik, N. (1960) Lancet, i, 1273.
tric artery is ligated, a gastrectomy clamp is applied to the stomach from incisura to fundus or to the adjoining greater curvature. A Hofmeister valve is constructed in the usual way; the stoma lies at the fundus and is at a higher level than the incisura. The extent of resection of acid-secreting area obeys the time-honoured principle of removing from a half to twothirds of the stomach in gastrectomy for duodenal ulcer. The stomach will now consist of a tube formed from the lesser curvature and part of the body of the stomach. The path of the food through this pouch will resemble as nearly as possible that in the normal stomach. In this way the food will be retained for a longer period in the stomach. Results
The operation was performed on ten patients and in all the postoperative period was smooth and uneventful. Fractional test meal performed one month after operation demonstrated a satisfactory reduction in acidity. Study of the gastric pouch by barium meal (fig. 2) one month after operation showed:
(1) The stoma lying in the region of the fundus and at a higher level than the incisura. Swallowed barium passed along the lesser curvature, collected in the region of the Hofmeister valve, which functioned in a way similar to the pyloric antrum, and then passed through the stoma into the jejunum. (2) The average emptying time of the gastric pouch was 2/z hours. The
and
so
of far all the
period
follow-up varies from 6 to patients are symptom-free.
20
months,
Summary A
line of resection of the stomach to prevent rapid emptying of the gastric pouch after gastrectomy for duodenal ulcer is suggested. The anatomical and physiological basis of this procedure is explained. The operation has been performed on ten patients. new
REFERENCES
Capper, W. M. (1951) Proc. R. Soc. Med. 44, 777. Edwards, H. (1954) Recent Advances in Surgery. London. Glazebrook, J. C., Welbourn, R. B. (1952) Brit. J. Surg. 40, 111. Machella, T. E. (1949) Ann. Surg. 130, 145. Wells, C. (1955) Ann. R. Coll. Surg. Engl. 16, 145.
GENITAL LISTERIOSIS IN THE MALE R. TOAFF
N. KROCHIK
M.D. Pisa
M.D. Cordoba
HEAD
ASSISTANT
DEPARTMENT OF OBSTETRICS A
M. RABINOVITZ B.A Beirut BACTERIOLOGIST
THE MUNICIPAL HOSPITALS,
TEL-AVIV, ISRAEL
WE have previously described a form of human listeriosis-genital listeriosis-as a latent infection of the genital organs of apparently healthy women by Listeria monocytogenes (Rabinovitz et al. 1959, Rappaport et al. 1960). This manifests itself by long-continued excretion of microorganisms from the uterine cervix, and by abortion or premature stillbirth in supervening pregnancies. At that time we thought genital listeriosis was a specific
disease of the female. A further step has been made by extending the bacteriological investigations to the male partners of habitual aborters. We now submit evidence that listerial infection may affect the genital organs of apparently healthy men, and cause impairment of reproductive capacity. While L. monocytogenes has never been isolated from
(Gray 1960), it has been isolated from the semen artificially infected sheep and goats (Khalimbekov 1957), and also from the testicles of a rabbit that died 6 days after nasal exposure and a ram killed 7 days after oral exposure (Osebold and Inouye 1954).
human
semen
of naturally and
Subjects and Methods Between November, 1959, and December, 1960,
we
examined the husbands of sixty women who had had repeated abortions. 1-8 semen examinations, but usually 3, were done in each case. The specimens were collected by masturbation after at least 5 days’ abstinence, to prevent fresh contamination of the penis and urethra by the female genital secretions. The men, none of whom had a urethral discharge, were asked to wash the penis and hands thoroughly with water and soap and to rinse them repeatedly with sterile water before masturbation. The ejaculate was collected in a sterile jar. Each specimen, after removal of a swab for bacteriological investigation, was examined routinely for volume, count, motility, and morphology. The swabs were cultured immediately, and then kept in a refrigerator for a month so that weekly cultures could be taken. The culture medium, the method of culture, and the criteria for identifying colonies in positive cases were the same as previously described (Rappaport et al. 1960).
In three
identified
as
cases the isolated microorganisms L. monocytogenes, serotype 4b.
were
THE FIRST CASE
A merchant of 47, born in Iraq but who had lived in Israel for 8 years, had been married for 12 years. His wife, aged 38, had had six spontaneous abortions (in the 2nd-4th months) in the first 10 years, and had since been sterile, despite a conservative operation for fibroids of the uterus. The first sperm examination, done in 1957, had shown: Quantity of ejaculate 1-5 ml. No. of spermatozoa 26 million per ml. 1-hour motility 40%, 3-hour motility 20%. Immature and abnormal forms numerous. Leucocytes and erythrocytes present.
During investigation of the wife L. monocytogenes, later identified as serotype 4b, was cultured successively from the cervical secretions on Dec. 3, 7, and 14, 1959. The sperm was therefore examined and cultured on Jan. 4, 1960: Quantity 1-5 ml. Sperm no. 58 million per ml. 1-hour motility 40%, sluggish; 4-hour 20%; 10-hour 10%. Abnormal and immature forms 26%. Culture: L. monocytogenes, later identified
as
serotype 4b.
Antibiotic treatment was started on Jan. 20. Procaine penicillin 17 million units was given in 14 days, followed by oral demethylchlortetracycline 12-6 g. in 14 days. On Feb. 22 the sperm examination was repeated: Quantity 2 ml. Sperm no. 52 million per ml. 1-hour motility 70%, very active; 4-hour 40%; 7-hour 40%; 24-hour 5%, sluggish. After this striking improvement, the wife was given treatment with crystalline penicillin 28 million units in 14 days. In May she conceived; and, after an uneventful pregnancy but with repeated courses of antibiotics, she was delivered by elective caesarean section of a healthy boy (birthweight 7 lb. 11 oz.) on Jan. 23, 1961. After conception, the husband refused further sperm examinations. THE SECOND CASE
A blacksmith of 37, born in Iraq but for 8 years in Israel, had been married for 6 years. His wife, aged 27, who was also born in Iraq, had once aborted in the 3rd month, and had had three premature stillbirths of macerated fcetuses at 8 months. During her fourth pregnancy, she was admitted to hospital with definite signs of placental insufficiency. Gram-positive rods were repeated by isolation from the cervical secretions, and these were later identified as L. monocytogenes, serotype 4b. Despite immediate antibiotic treatment, the foetus died in utero. The husband’s sperm was examined shortly afterwards (on
483 Dec. 30,
1959), when the couple had
not
yet resumed inter-
course :
Quantity 1-5 ml. Sperm no. 23 million per ml. 1-hour motility 25%, 4-hour 15%. Eosin tests 65% and 45%. Abnormal and immature forms 35 Cultures: repeatedly positive for L. monocytogenes, serotype 4b. A bilateral testicular biopsy was performed on Feb. 18, 1960. No gross pathologic changes were observed (Dr. C. Joel), no bacilli were found in gram-stained histological sections, and cultures from the biopsy specimen remained sterile. The wife, who had been treated repeatedly with antibiotics (penicillin, demethylchlortetracycline, and chloramphenicol), conceived again with unexpected ease after 3 months. Her fifth pregnancy was uneventful and she was delivered of a normal boy by elective caesarean section on Sept. 6, 1961. The husband has not had antibiotics, and in October, 1961, sperm examination showed: Quantity 1-5 ml. Sperm no. 33 million per ml. &mid ot;
1-hour motility 65%, 4-hour 40%. Abnormal and immature forms 35 Repeated cultures: negative for L. monocytogenes. Only Proteus vulgaris was grown, the presence of which may possibly prevent the growth of listeria. THE THIRD CASE
An engineer of 34, born in Austria, who had lived in Israel for 24 years, had married at the age of 30. His wife, aged 32, had had two pregnancies, which had both ended in early abortions in February and November, 1958. During investigation to establish the cause of the infertility, a sperm examination was made on Jan. 20, 1959: Quantity 4 ml. Sperm no. 51 million per ml. 1-hour motility 50 %, 2-hour 30 %. Abnormal and immature forms 62%. Mucolysis incomplete after 3 hours. On Jan. 29 the examination was repeated: Quantity 3 ml. Sperm no. 102 million per ml. 1-hour motility 30 %, 4-hour 10 % Abnormal and immature forms 67%. A testicular biopsy specimen, taken on Feb. 5, revealed "impaired spermatogenesis, catarrh of the seminiferous tubules with considerable shedding of cells, and a reduced number of spermatozoa " (Prof. A. Laufer). Hormonal tests of the urine showed: 17-ketosteroids, 28 mg. per 24 hours; oestrogenic substances, less than 25 i.u. per litre; folliclestimulating hormone 50 r.u. per litre. Rebound treatment with large doses of testosterone was given during June and July. 4 months later the sperm-count was back to normal, but there was no change in the motility or cell form. 3 specimens were therefore cultured on Dec. 31, 1959, and Jan. 3 and 16, 1960. The first and third were positive for L. monocytogenes, and the first was later identified as serotype 4b. Treatment was started in February, 1960, with demethylchlortetracycline 8’4 g. in 14 days, followed by procaine penicillin 11,200,000 units in 14 days. But 4 months later sperm examination was still very unsatisfactory: Quantity 3-5 ml. Sperm no. 34 million per ml. 1-hour motility 45%. Abnormal and immature forms 38%. After a further course of demethylchlortetracycline 12-6 g. in 14 days, sperm examination (on Nov. 16) showed: Quantity 4 ml. Sperm no. 78 million per ml. 1-hour motility 75%, 4-hour 55%, 24-hour 15 Abnormal and immature forms 28%. Culture: negative. About this time 8 cultures from the wife’s cervical secretions were constantly negative. Shortly afterwards she conceived ; the pregnancy was uneventful, and a healthy boy was delivered on Jan. 25, 1962. &mid ot;
&mid ot;
Discussion
We have found dyspermia (in the form of reduced spermcount, mobility, and viability of the spermatozoa, teratospermia, and incomplete mucolysis of the seminal fluid) associated with L. monocytogenes in the ejaculate of three men whose wives had sought advice over repeated miscarriages. Two of the women had genital listeriosis, while in the third listerial infection could not be proved. It is therefore important to know whether the presence of
listeria in the ejaculate is a manifestation of active infection of the male genital organs, with xtiological significance in the production of dyspermia, or whether it is merely the result of contamination of the male urethra by the genital secretions of chronically infected women. To reduce the chances of fresh contamination of the urethra, abstinence was the rule-for 5 days before the semen was collected for bacteriological study. Case 2 had abstained for much longer, however, and in case 3 the wife was apparently unaffected by genital listeriosis. Thus passive contamination does not seem to explain the presence of L. monocytogenes in the ejaculate of at least two of the three cases under discussion. But a stronger argument favouring this negative conclusion in all three subjects concerns the nature of the dyspermia; its characters, and the excellent results of antibiotic treatment, point more to a chronic infection of the adnexa than to
faulty spermatogenesis. The finding of L. monocytogenes in the semen and testicles of animals shortly after exposure to infection by other than the genital route (Khalimbekov 1957, Osebold and Inouye 1954) supports the possibility that there may be genital localisation of listeria in man. None of our patients had urethral symptoms. Testicular localisation is not borne out by the normal biopsy findings in case 2, but it cannot be excluded in case 3, where there was the possibility of a mild orchitis. The absence of gram-positive rods in stained slides does not prove the contrary. Treatment with penicillin and demethylchlortetracycline restored the impaired reproductive capacity in two of the three affected men. In all three women, normal pregnancy followed the detection and treatment of listerial infection and resulted in a healthy child after multiple pregnancies which had ended in miscarriages. In the two cases where both husband and wife were affected, the listeria strains belonged to serotype 4b. This would be compatible with venereal transmission of the infection, but it does not prove it because all nine cases of genital listeriosis which we have serologically typed belonged to this same strain, which seems to be prevalent in this country.
Summary The semen of sixty husbands of habitual aborters were submitted to bacteriological investigation. In three cases Listeria monocytogenes, serotype 4b, was isolated, and the quality of the sperm was poor. The characters of the dyspermia pointed to chronic infection of the adnexa in two cases, and to testicular localisation of the infection in the third. Two of the wives had genital listeriosis, caused by the same strain of listeria (serotype 4b). After detection of the listerial infection and antibiotic treatment, the impaired fertility was restored and normal babies were born. We are indebted to Prof. H. P. R. Seeliger, of the Institute of Hygiene, University of Bonn, and Dr. M. L. Gray, of the Veterinary Research Laboratory, Montana State College, Bozeman, for the identification and typing of cultures; to Dr. C. A. Joel, of the Institute for the Research and Treatment of Infertility, Municipal Hospital, Tel-Aviv, for the testicular biopsy in case 2, and to Prof. A. Laufer, of the Institute of Pathology, Hadassah University Hospital, Jerusalem, for the testicular biopsy in case 3. This work was supported in part by a research grant from the Lederle Division of Cyanamid International, Pearl River, N.Y.; and they also supplied the demethychlortetracycline (’Ledermycin’). REFERENCES
Gray, M. L. (1960) Lancet, ii, 315. Khalimbekov, M. M. (1957) Vet., Moscow, 34, 17. Osebold, J. W., Inouye, T. J. (1954) J. infect. Dis. 95, 52, 67. Rabinovitz, M., Toaff, R., Krochik, N. (1959) Harefuah, 57, 277. Rappaport, F., Rabinovitz, M., Toaff, R., Krochik, N. (1960) Lancet, i, 1273.